HIMSS 2022: Today’s Big Topics in Healthcare

Today’s big topics in the HIMSS 2022 agenda include patient safety, patient education, the patient experience, burdens on clinicians, public health, wearables and emerging technologies. Since these are going to be discussion points at this year’s conference, the JPSys social media team decided to ask one of our Clinical Informatics Specialists to weigh in on the conversation.

Dr. H. Alpha Garrett, M.D., is an anesthesiologist who has spent 20 years working in anesthesiology and critical care. He has also worked in clinical informatics and information technology, supporting the National Library of Medicine (NLM) and the National Cancer Institute (NCI). He has spent a lot of time working with and for patients and has a lot to say on the patient experience.

Q: What do you see as today’s biggest healthcare issues?

A: First, there’s a lot of pressure on the provider to push patients through the system to generate billable units as opposed to taking care of the patient. There’s also a lot of excess documentation and proliferation of documentation, which is not helpful in many cases. It often detracts from the doctor-patient relationship.

As for the role EHRs play in patient care, ideally electronic health records and systems should help everyone from the time a patient shows up for medical care. It helps the receptionist check you in. It helps the nurse record pertinent data elements, and it helps the physician order the appropriate tests or interventions. Hopefully, it promotes good outcomes for patients, as some of that data can be used for tracking outcomes. But often, it can be difficult to use and become burdensome, and it’s dubious as to whether some of the additional information entered is actually helping the patient, much less the people working in healthcare. 

Q: What other concerns do you have regarding patient safety and the patient experience?

A: I’ve always thought that the ultimate responsibility, where the buck stops, lies for the most part with the physician. Even today, none of the EHRs with their clinical decision support (CDS) actually say, “We’re responsible.” As with all software systems, the EHRs have disclaimers that say, if our system doesn’t work, the vendor is not liable.  Patient safety relies on the ability of the physician to remain current, make an appropriate diagnosis, and prescribe the right treatment for the right condition. However, it does help to have things like pharmacy information systems for drug interactions and allergy checking. I might not know a drug interaction for something that just came on the market eight months ago. These systems extend your ability to access information that might otherwise be too much to carry in one person’s mind.

Ideally, the physician and/or patient should be the patient’s advocate. The patient should have some responsibility.  Today it’s almost like the patient has no responsibility. We can’t take the patient out of the equation. We need to educate them to the extent that they are able to understand and recognize that they have a vital role and responsibility in their care.

Q: What could healthcare and Health IT professionals learn to make the patient experience better?

A: There are gradations of what it means to be a Health IT professional. There are different levels of knowledge and different component occupations (e.g., LPN versus an RN or advanced practice nurse versus a physician versus specialist physician, etc.). As such, expectations vary regarding how they can improve the patient experience. EHRs should present the right information to the right person at the right time. To the extent HIT systems do that, you have a win. To the extent that they don’t, it’s a loss. Each of us has our own lens through which we view the world. We should always keep the bigger picture in mind, which in my mind boils down to patient safety and patient satisfaction balanced against aggregate cost. In the end, if it is not affordable, there is no service provided.

It’s also well known that too many alerts or warnings can give providers alert fatigue, at which point the system becomes less useful. Similarly, you can’t present a provider with too many choices because then you get choice overload, and the system loses its efficacy. So, when we’re talking about EHR systems, always consider the end user and consider the unintended consequences. Consider: How easy is it for providers to use? How fast is the system? How many choices do you permit on a drop-down menu?  How many alerts are presented when ordering an intervention? How can this help a patient?

Q: What are your thoughts on emerging technologies in the healthcare space?

A: Wearables are a big thing, but they are still in their infancy.  They can fall into the realm of over testing patients because of improperly interpreted data. If a test indicates a problem, you usually proceed to something that’s more invasive, that has a defined risk, which may be greater than the number of people whose health you improve by over testing. 

An example would be abnormal EKG’s. A healthcare professional might say, “We need to do EKGs on everyone over a certain age, because of the incidence of heart disease.” If that professional sees abnormal results on the 12-lead, that could lead them to perform unnecessary invasive tests, which because of their inherent risk, could end up doing more harm than good. So, we should have a degree of skepticism with the data that comes from new technologies as we integrate new data points into an individual’s health record. 

I am always wary of the mindset of “We have to do something.” In my experience, often this results in a less desirable outcome than if we did nothing at all. Therefore, and to the extent possible, we should evaluate all things empirically to determine the benefit of any intervention. 

That’s not to say that we shouldn’t explore the application of new technologies; they provide a new lens to observe health phenomena. The real-time aspects of the data streams are exciting and will hopefully promote the health of all who have access to it.